After successful liver transplantation (LTx), excessive weight gain is comm
on among recipients. This rapid change in body morphology has been attribut
ed to immunosuppressive regimens. The liver's role as a metabolic sensor an
d its autonomic innervation are pivotal in relaying humoral and neural info
rmation to the hypothalamus, where ingestive behavior is determined and has
largely been ignored. We examined and assessed the contribution of drugs,
energy intake, and energy expenditure on weight gain after LTx. Twenty-thre
e patients were followed up at 3-mo intervals after LTx. Energy expenditure
was measured by indirect calorimetry and dietary intake by diet diaries, a
nd body composition was assessed with anthropometry and multifrequency bioe
lectrical impedance analysis. Cumulative drug doses were calculated, and as
sociations between body composition and immunosuppressive regimens and ener
gy expenditure were examined. Nine months after LTx, 20 of 23 (87%) recipie
nts were overweight or obese, despite three-fourths of this cohort being on
weight-reduction regimens. After LTx. a decrease in measured energy expend
iture was observed (60.3 +/- 1.6 kJ/kg of body cell mass pre-LTx versus 53.
7 +/- 2.3 kJ/kg of body cell mass after 9 mo; P < 0.05). Multiple stepwise
regression analysis showed that, when adjusted for body weight, the stronge
st predictor of fat mass at 9 mo after LTx was resting energy expenditure.
Weight gain after LTx is not predicted by immunosuppressive drug dosage. Th
e strong association between weight gain and energy economy might be a cons
equence of the loss of hepatic metabolic integration and accelerated furthe
r by increased energy intake. Effective management of weight gain will not
be achieved until the mechanisms involved in altered energy homeostasis are
elucidated. (C) Elsevier Science Inc. 2001.